The intention-behaviour gap in physical activity: a systematic review and meta-analysis of the action control framework

Goal conflict and the physical activity intention-behavior relationship: Insights from a study of People's daily experiences

Although intention is a strong predictor of moderate-to-vigorous intensity physical activity (MVPA), several factors moderate the intention-behavior relationship. People experience goal conflict when one or more of their goals makes it more difficult to pursue other goals. Goal conflict was examined as a moderator of the intention-behavior relation using data from ecological momentary assessments and accelerometer-derived estimates of MVPA. Participants (N = 100; 22 males) wore an accelerometer and responded to digital surveys assessing MVPA intentions and goal conflict up to four times daily for seven consecutive days. MVPA in the 180-min epoch following each survey prompt was recorded. Multilevel modelling was used to analyze the data using the disaggregated between- and within-person effects. Results revealed an intention-behavior gap of 30% and significant within-person effects for intention and goal conflict. Within-person goal conflict moderated the intention-behavior relationship such that when people had stronger intentions to be active compared to their average level of intention, they engaged in more MVPA; and when goal conflict was higher, compared to their average level of goal conflict, people engaged in less MVPA. Findings suggest experiencing higher goal conflict about engaging in MVPA thwarts people's abilities to follow through with their intentions to be active throughout the day.

Effectiveness of behavior change techniques to address barriers to follow-up colonoscopy: results from an online survey and randomized factorial experiment

BACKGROUND

Nonattendance at colonoscopy is associated with reduced colorectal cancer (CRC) survival.

PURPOSE

The aim of this research was to quantify barriers to colonoscopy and test the effectiveness of behavior change techniques (BCTs) to address them.

METHODS

Two studies were conducted. In the first study, participants were asked to imagine their next CRC screening result was abnormal, and were presented with the standard abnormal result letter used in the English CRC Screening Programme. Participants then completed a short survey. Multivariate regression tested associations between perceived barriers and intentions. In the second study, participants were randomly presented with a modified version of the abnormal results letter, which incorporated one or more BCTs, designed to target barriers identified in study 1, using a 28 factorial design. Participants then completed the same survey used in study 1. Multivariate regression tested the effectiveness of the BCTs to modify target barriers and intentions.

RESULTS

In study 1, 5 items were associated with intentions, namely "Lack of understanding that CRC can be asymptomatic," "Perceived importance of screening," "Transport/travel," "Shared decision making and family influenced participation," and "Fear of pain and discomfort" (all P's < .05). In study 2, the inclusion of a social support message, targeting "shared decision-making and family influenced participation," facilitated independent decision making and increased intentions (both P's < .05). There was no evidence to support the remaining 7 BCTs to modify barriers or intentions (all P's < .05).

CONCLUSIONS

Inclusion of a social support message facilitated independent decision-making and improved intentions.

Psychological Determinants of Health Behavior

This review provides a critical overview of current evidence on psychological health behavior determinants and its value in informing intervention and future determinants research. The review begins with work labeling and classifying the myriad of determinants available in the extant research to arrive at core groups of determinants. Next, the conceptual bases of these determinant groups are identified, and the weight of the evidence for their purported effects on health behavior, including belief-based determinants (e.g., outcome expectancies, capacity beliefs), determinants representing self-regulatory capacity (e.g., planning, action control) and nonconscious processes (e.g., habit, implicit cognition), and dispositional determinants (e.g., personality, regulatory control), is critically evaluated. The review also focuses on the theory-based mechanisms underpinning determinant effects and moderating conditions that magnify or diminish them. Finally, the review recommends a shift away from research on determinants as correlates, outlines how determinants can inform intervention development and mechanisms of action tests, suggests alternatives to predominant individualist approaches, and proposes future research directions.

Prevailing theories describing sports-related concussion symptom reporting intent and behavior among adolescent athletes: a scoping review

Diagnosis of sports-related concussion (SRC) primarily relies on an athlete's self-report of injury and associated symptoms. Social pressures and attitudes surrounding SRC influence athlete reporting behavior. Unfortunately, underreporting of SRC symptoms is an issue among adolescent athletes. Nondisclosure of SRC symptoms may lead to premature return-to-play and potential persistent symptoms. This scoping review summarizes prevailing theories that explain SRC symptom reporting intent and behavior among adolescent athletes. Literature was reviewed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Review guidelines. Inter-rater reliability was calculated at each stage. Thirty-four articles published between 2013-2024 were included. Inter-rater reliability was fair to perfect across all review stages. Of the 16 unique theories described, the Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB) was the most frequently cited theory explaining SRC symptom reporting behavior. Although the TRA/TPB framework was useful when predicting SRC symptom reporting intent, it did not adequately predict reporting behavior, consistent with the broader health behavior literature which has established that intention is not a good predictor of behavior. In light of these findings, new frameworks must be considered that consider neurodevelopmental, cognitive, and cultural factors, as these may be more useful for understanding SRC symptom reporting behavior in adolescence.

A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

Operationalization of the social cognitive theory to explain and predict physical activity in Germany: a scale development

Introduction

Social cognitive theory is one of the most prominent psychological theories regarding human behavior. Previous research tested and confirmed parts of the theory concerning the explanatory and predictive value of the theory, both in specific populations and in selected domains of physical activity. However, the value of this research is limited as researchers often use their own item sets rather than validated scales. Therefore, comparability of the studies is restricted and the quality of the individual findings can often not be conclusively assessed as psychometric properties of the measurement are unclear. The goal of this research was to develop a parsimonious, reliable, and valid questionnaire to assess the elements of SCT in the context of physical activity.

Methods

In total, 90 items were developed for the four factors of SCT, which were then examined by exploratory factor analysis and reduced to 18 items in total.

Results

Cross-validation was successful. Internal consistency was good for the four subscales, test-retest reliability was satisfactory, as were indicators for convergent and divergent validity.

Discussion

A short, reliable, and valid instrument was developed intended for use in the general adult population in Germany for research on theoretical assumptions and interventions based on social cognitive theory.

Association Between Self-Reported Protective Behavior and Heat-Associated Health Complaints Among Patients With Chronic Diseases in Primary Care: Results of the CLIMATE Pilot Cohort Study

BACKGROUND

As a result of climate change, exposure to high temperatures is becoming more common, even in countries with temperate climates. For patients with chronic diseases, heat poses significant health risks. Empowering patients is a crucial element in protecting the population from the adverse effects of heat. In this context, self-reports of protective behavior are often used to gain a mutual understanding of patients' issues. However, the extent to which self-reported behavior is associated with health complaints remains unclear.

OBJECTIVE

This study aims to describe the association between light to moderate heat and health complaints in everyday life, and to analyze whether self-reported protective behavior and related psychosocial factors are linked to these complaints.

METHODS

We conducted a pilot cohort study using internet climate data merged with an online survey of patients with chronic diseases recruited through general practitioner practices. Patients were eligible if they were 18 years or older and had at least one chronic disease. The heat was modeled using temperature and humidity data. Health complaints were assessed through up to 7 follow-up evaluations on the hottest day of each week during the observation period. Data were analyzed using 3 nested models with mixed effects multivariable linear regression, adjusting for random effects at the climate measuring station and participant levels. Model 1 included heat exposure, sociodemographic data, and chronic diseases. Model 2 added protective behavior and health literacy, while model 3 incorporated self-efficacy and somatosensory amplification (ie, the tendency to catastrophize normal bodily sensations such as insect bites).

RESULTS

Of the 291 eligible patients, 61 (21.0%) participated in the study, providing 294 observations. On average, participants were 61 (SD 14) years old, and 31 (51%) were men. The most prevalent conditions were cardiovascular diseases (n=23, 38%) and diabetes mellitus (n=20, 33%). The most commonly reported symptoms were tiredness/fatigue (232/294 observations, 78.9%) and shortness of breath (142/294 observations, 48.3%). Compared with temperatures of 27°C or lower, a heat index between over 27°C and 32°C (β=1.02, 95% CI 0.08-1.96, P=.03) and over 32°C (β=1.35, 95% CI 0.35-2.35, P=.008) were associated with a higher symptom burden. Lower health literacy (β=-0.25, 95% CI -0.49 to -0.01, P=.04) and better self-reported protective behavior (β=0.65, 95% CI 0.29-1.00, P<.001) were also linked to increased symptom burden but lost statistical significance in model 3. Instead, lower self-efficacy (β=-0.39, 95% CI -0.54 to -0.23, P<.001) and higher somatosensory amplification (β=0.18, 95% CI 0.07-0.28, P=.001) were associated with a higher symptom burden.

CONCLUSIONS

Compared with colder weather, light and moderate heat were associated with more severe health complaints. Symptom burden was lower in participants with higher self-efficacy and less somatosensory amplification. Self-reported protective behavior was not linked to a lower symptom burden. Instead, we found that patients who tended to catastrophize normal bodily sensations reported both better protective behavior and a higher symptom burden simultaneously.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05961163; https://clinicaltrials.gov/ct2/show/NCT05961163.

Mindfulness improves psychological health and supports health behaviour cognitions: Evidence from a pragmatic RCT of a digital mindfulness-based intervention

BACKGROUND

Mindfulness-based interventions can improve psychological health; yet the mechanisms of change are underexplored. This pre-registered remote RCT evaluated a freely accessible digital mindfulness programme aiming to improve well-being, mental health and sleep quality. Health behaviour cognitions were explored as possible mediators.

METHODS

Participants from 91 countries (N = 1247, Mage = 27.03 [9.04]) were randomized to 30 days of mindfulness practice or attention-matched control condition. Measures of well-being, depression, anxiety, stress, sleep quality, barriers self-efficacy, self-regulation and behavioural predictors (e.g., attitudes and behavioural intentions) were taken at baseline, 1-month (post-intervention) and 2-months (follow-up). Linear regression examined intervention effects between and within groups. Longitudinal mediation analyses explored indirect effects through health behaviour cognitions.

RESULTS

Three hundred participants completed post-intervention measures. Those receiving mindfulness training reported significantly better well-being (Mdifference = 2.34, 95%CIs .45-4.24, p = .016), lower depression (Mdifference = -1.47, 95%CIs -2.38 to -.56, p = .002) and anxiety symptoms (Mdifference = -.77, 95%CIs -1.51 to -.02, p = .045) than controls. Improvements in well-being and depression were maintained at follow-up. Intervention effects on primary outcomes were mediated by attitudes towards health maintenance and behavioural intentions. Mediating effects of attitudes remained when controlling for prior scores in models of depression and well-being.

CONCLUSIONS

Digital, self-administered mindfulness practice for 30 days meaningfully improved psychological health, at least partially due to improved attitudes towards health behaviours and stronger behavioural intentions. This trial found that digital mindfulness is a promising and scalable well-being tool for the general population, and highlighted its role in supporting health behaviours.

Predicting physical activity behavior among university students using the multi-process action control framework

Most university students do not engage in enough physical activity (PA) despite the known physical and mental health benefits. Action control theories such as the Multi-Process Action Control (M-PAC) framework have been proposed to better understand the translation of intentions into action by incorporating post-intentional processes. However, the explanatory power of the M-PAC framework beyond traditional social cognitive constructs has received limited attention. This study examined the predictive utility of the M-PAC framework for explaining variance in self-reported and device-measured PA behavior among university students. A total of 2418 undergraduate students (Mean age = 19.1 ± 1.73 [SD] years) completed an online survey that included a self-reported measure of moderate-to-vigorous PA (MVPA) as well as constructs outlined in the M-PAC framework: instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit and identity. A subsample (n = 376) also wore an ActiGraph wGT3x-BT accelerometer on their non-dominant wrist for seven full days to assess MVPA. Robust linear regression models were computed to investigate associations between M-PAC framework constructs and PA behavior. Findings showed the M-PAC framework explained as high as 14.3 % and 37.9 % of the variance in device-measured and self-reported MVPA, respectively. Regulatory (behavioral regulation), and reflexive (habit and identity) processes were significant predictors of self-reported MVPA when examining the full M-PAC framework, whereas the role identity dimension of PA identity was the only significant predictor of device-assessed MVPA. Taken together, these results reinforce the importance of post-intentional processes, specifically role identity, in understanding PA behavior among university students.

Uncovering the roles of automatic attitudes and controlled processes in the regulation of physical activity behavior in children

Despite substantial research efforts to increase engagement in physical activity (PA), children are not sufficiently active. Dual-process theories suggest that PA behavior regulation occurs through both controlled (i.e., reflective, conscious) and automatic (i.e., non-reflective, less conscious) processes. Automatic processes depend on affective valuations and attitudes towards PA and have been shown to predict PA behavior. However, their role in PA behavior regulation in children remains unclear. Therefore, the current study investigated the unique association of automatic attitudes towards PA on self-reported seven-day PA recall, after accounting for the effects of known controlled precursors of PA (i.e., explicit attitudes, PA self-efficacy, and PA intentions). In a cross-sectional design, 69 children (age = 10.8 ± 0.6 years) completed the Single-Category Implicit Association Task (SC-IAT) and self-reported measures of PA and controlled precursors of PA. In a hierarchical regression analysis, controlled processes accounted for 28.3 % of the variance in PA behavior. Although the bivariate association between automatic attitudes and PA was not significant, the association between them became significant but negative in the fully adjusted model (b = -1.70; p = 0.025). The fully adjusted model accounted for 35.0 % of the variance in PA. In summary, the findings indicated that both controlled and automatic processes predicted PA in children, although the association with automatic attitudes was not in the expected direction in the adjusted model. Future studies are warranted to further understand the role of automatic processes in the regulation of PA behavior in children.

Predictive Utility of the Multi-Process Action Control Framework for Self-Reported and Device-Measured Physical Activity Behavior of Adolescents

Understanding the correlates of physical activity behavior is imperative for informing the development of interventions to address the low rates of physical activity guideline adherence among adolescents living in the United States. This cross-sectional study examined the predictive utility of the Multi-Process Action Control (M-PAC) framework for explaining self-reported and device-measured physical activity behavior among a Hispanic-majority sample of adolescents. A total of 1849 high school students (mean age = 16.0 ± 1.22 SD years; 52.3% women; 87.8% Hispanic) enrolled in one school district in south-central Texas completed a survey including instruments to assess M-PAC framework constructs (instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit, identity) and moderate-to-vigorous physical activity (MVPA) behavior. A subsample (n = 435) wore accelerometers for seven days. The results from robust linear regression models revealed role identity and habit were significant predictors of self-reported MVPA. Role identity was a significant predictor of accelerometer-derived daily MVPA and raw acceleration in the most active hour but not daily raw acceleration. The findings indicated reflexive processes are robust predictors of adolescent physical activity and should be the focus of interventions designed to promote adoption and maintenance of physical activity during this developmental life stage.

Restaurant waiting staff's intention to dissuade customers from over-ordering: an extended theory of planned behaviour

Purpose

This study aims to validate the impact of waiting staff’s attitudes, subjective norms, and perceived behavioural control on customer dissuasion from over-ordering and identify their antecedents using an extended theory of planned behaviour.

Design/methodology/approach

We selected three categories of restaurants (30 in total, including fine dining, casual dining, and fast food) in Macao and Zhuhai (China) for conducting the survey using a purposive sampling approach. The respondents were waiting staff who took customers’ orders in the past three months. In total, 393 valid responses were used for a structural-equation-modelling analysis.

Findings

The results show that restaurant waiting staff’s attitudes, subjective norms, and perceived behavioural control have positive effects on their intention to dissuade customers from over-ordering. Our study further reveals that perceived behavioural control is far more influential than attitudes and subjective norms on restaurant employees’ intentions to intervene with over-ordering. We also validate seven antecedents, including environmental concern and communication for attitudes, peer influence, supervisor influence, and organisational support for subjective norms, and self-efficacy and training for perceived behavioural control.

Originality/value

The food-waste literature tends to focus on consumers in home and restaurant settings and has paid scarce attention to the role of restaurant waiting staff in intervening in consumers’ waste behaviours. We fill in this research gap by revealing a formation mechanism for waiting staff’s intention to dissuade over-ordering.

Exercise identity and physical activity behavior during late adolescence: A four wave cross-lagged panel model

Research has shown that physical activity behavior tends to decline across adolescence before stabilizing in adulthood. Identifying salient factors underlying these behavioral changes is therefore imperative for informing intervention development. This study explored the temporal nature of the relationship between exercise identity and physical activity behavior during the transition out of high school. An analysis of data from the Application of integrated Approaches to understanding Physical activity during the Transition to emerging adulthood (ADAPT) prospective cohort study was conducted, involving 1451 Canadian adolescents (Mage = 15.93 ± 0.53 years; 52.4% female). Participants completed the International Physical Activity Questionnaire-Short Form to report weekly moderate-to-vigorous physical activity and an abbreviated version of the Exercise Identity Scale yearly for four years beginning in Grade 11. A four-wave cross-lagged panel model was used to test bi-directional associations between exercise identity and physical activity behavior. Significant auto-regressive effects for exercise identity and physical activity were observed across all four time points. Significant positive cross-lagged paths were observed for exercise identity predicting future physical activity at all time points; however, none of the cross-lagged paths with physical activity predicting future exercise identity were significant. Collectively, these findings support existing theory that emphasizes the role that identity plays in physical activity behavior. Interventions seeking to attenuate the physical activity declines typically observed during the transition to emerging adulthood should therefore consider adopting behavior change techniques that target identity, as it appears to be an important psychological determinant underlying future physical activity engagement.

A web-based physical activity intervention targeting affect regulation: a randomized feasibility trial

Early career professionals (ECPs) are a critical target for physical activity (PA) promotion. Affect contributes to an established PA intention-behaviour gap and is pertinent among ECPs.

OBJECTIVE

The purpose of this study was to examine the feasibility and acceptability of a web-based intervention and explore the effects on secondary outcomes (moderate-to-vigorous PA (MVPA), emotion regulation, multi-process action control constructs).

METHODS

Adults aged 25-44 who were employed at least part-time in a desk-based job and not meeting PA guidelines (<150 min MVPA) were recruited and randomized into a 6-week online intervention integrating acceptance and commitment principles and affect regulation strategies, or a control group.

RESULTS

Forty adults were recruited and randomized to the web-based intervention (n = 21) and waitlist control (n = 19). The recruitment rate was 29%, retention was 75%, engagement was 68%, and satisfaction was high in both quantitative and qualitative assessment. Participants allocated to the intervention improved MVPA (ηp2=0.30), emotion regulation (ηp2 =0.49), behavioural regulation (ηp2=0.53), affective attitude (ηp2=0.23), identity (ηp2=0.24), and constructs of mindfulness (ηp2=0.44), and valued living (ηp2=0.20).

CONCLUSIONS

Primary outcomes concerning feasibility were adequate and secondary outcomes improved, suggesting a full-scale randomized controlled trial is feasible with minor modifications. A large-scale study is warranted to establish intervention effectiveness.

Metabolic syndrome and its association with physical activity in Sudanese early adolescents - Khartoum state, Sudan: An observational study

The growing prevalence of overweight/obesity in adolescents highlights the significance of studying metabolic syndrome (MetS) in increasingly sedentary adolescents. To date, no study in Sudan has examined the association between MetS and physical activity (PA) among adolescents. This study aimed to assess the association between MetS and its components and PA among Sudanese early adolescents. A cross-sectional assessment was conducted from to 2018 to 2019 on a sample of 921 primary school students from Khartoum State, Republic of Sudan. MetS was defined according to the International Diabetes Federation criteria and a standardized questionnaire was used to assess PA. Metabolic equivalents of task were calculated, and levels of different intensities of PA (tertiles) were identified accordingly. The association between PA and MetS and its components was assessed using a logistic regression model. The participants comprised 388 boys and 533 girls with a mean age of 12.59 ± 1.21 years. The prevalence of MetS was significantly higher in subjects in the 1st PA tertile (least active) than in the 2nd and 3rd (most active) tertiles of PA, and this difference was observed in both boys and girls. After adjusting for other study factors, the odds of MetS among adolescents in the 1st PA tertile were 7 times higher than those in the highest PA tertile (adjusted odds ratio = 7.01, 95% confidence interval: 1.48, 32.99). A physically inactive lifestyle was associated with higher odds of MetS and its components, especially waist circumference and triglyceride levels, in Sudanese early adolescents. This study highlights the importance of promoting PA in this age group.

A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial

BACKGROUND

Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children's behavioral patterns are largely governed by familial structures. Similarly, parents' activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents.

OBJECTIVE

This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline.

METHODS

Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures.

RESULTS

This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention's effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024.

CONCLUSIONS

The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55960.

Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study

BACKGROUND

People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy.

OBJECTIVE

The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes.

METHODS

Of the intervention's 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes.

RESULTS

Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=-1.04, SE 0.50, 95% CI -0.06 to -2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04).

CONCLUSIONS

We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.

Translating Physical Activity Intentions into Behavior: Reflective, Regulatory, and Reflexive Processes

The purpose of this article was to review predictors of the physical activity (PA) intention-behavior relationship. The review provides evidence for the hypothesis that reflective (consciously deliberated expectations of PA), regulatory (tactics used to enact intentions), and reflexive (stimulus-based associative motivation) processes represent independent determinants of translating PA intentions into action, yet differ in relative contribution across time and circumstance.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.